- Email: [email protected]
EFFECTS OF 1983 MENTAL HEALTH ACT
1426 scale. Results were analysed by Pearson’s correlation coefficient (r):
countered
by
calm debate about the failure of the definition and
guidance to a better one. HAD
Self-assessment
Climcal assessment
0-65 0-69
0-44 0.62
Anxiety Depression All r values
significant (p<0
00 1).
Department of Psychiatry, University of Leeds, St James’s University Hospital,
R. P. SNAITH C. M. TAYLOR
Leeds LS9 7TF
Thus the HAD scale correlates well with other self-assessment and clinical assessment scales, the clinical ones requiring a long interview with a highly trained person. Our interest in the epidemiology of anxiety and depression in medical populations prompted us to wonder if the use of this instrument could be extended from a symptomatic approach to a diagnostic one. We did a second study, this time in 133 patients admitted to the same hospital department.2 We compared HAD results with those of a structured questionnaire adapted from the composite international diagnostic interview.3 This interview4 permits the diagnosis of affective disorders according to DSM 111. The results, with a current major depressive episode as an external validation criterion, vary greatly according to the cut-off score of the HAD:
Taylor CM Irritability Definition, assessment and associated factors. Br J Psychiatry 1985, 147: 129-36
1. Snaith RP,
EFFECTS OF 1983 MENTAL HEALTH ACT
SIR,-In 19841 we reported a reduction in the use of emergency and 6 month orders for the first six months after the new mental health legislation came into force on Sept 30, 1983. This change has been maintained, as has the change to using the 28 day order in preference to the 6 month and emergency orders (table). IMPACT OF
1983 MENTAL
HEALTH LEGISLATION ON ADMISSIONS
UNDER SECTION
HAD
Cut-off Senmivlly (%) 8 9 10 11
77-7 72.2 69-4
SpecificllY (%) 80-4 83-5 87.6 90-7
PVP (%) 59-6 61-9 67-9 67-8
PVN (%)
52’8 PVP, PVN=predicuve values of positive, negative result.
90-7 89 88,5 83-8
Thus, as the cut-off increases, sensitivity is reduced while specificity improves. Since there is a high prevalence of anxious and depressive disorders in medical patients, a quick assessment scale to evaluate the degree of psychopathology is of interest. However, even though the HAD scale correlates with other quantitative psychopathological scales, one must be careful when using it for diagnostic purposes. Used to evaluate the prevalence of depression in medical settings (outpatient or inpatient), this assessment scale can only provide an estimate of depressive symptoms; it cannot be used to study depressive disease.
*Sections of 1959 Mental Health Act
m
parentheses Years in this table run Oct 1 to Sept 30.
These findings suggest that, for Southampfon, the changes noted for the first six months were not the transitory result of the novelty of a new procedure, but a permanent change in medical and social work practice before people are, in their own interests, deprived of
liberty. Department of Psychiatry, Royal South Hants Hospital, Southampton SO9 4PE
M. J. WINTERSON B. M. BARRACLOUGH
MJ, Barraclough BM. Effects of 1983 Mental Health Legislation compulsory admissions to a District General Hospital Lancet 1984, ii. 44
1 Winterson
Psychiatric and Internal Medicine Services, Hôpital Bichat,
J. P. LEPINE M. GODCHAU P. BRUN
75018 Paris, France
on
PLASMA CONCENTRATION OF ATRIAL NATRIURETIC POLYPEPTIDE IN ESSENTIAL
HYPERTENSION 1.
2.
Lepine JP, Godchau M, Brun P, Lemperière Th. Evaluation de l’anxiété et de la dépression chez des patients hospitalisés dans un service de médecine interne. Ann Médico-Psychol 1985; 2: 175-89. Lepine JP, Godchau M, Brun P. Utilité des échelles d’auto-évaluation de l’anxiété et de la dépression en médecine interne. Presented at 3rd International Congress of the International Federation of Psychiatric Epidemiology (Brussels, Sept 9-11, 1985) Abst 119.
3. Wing J, Robins L, Helzer J, Stoltzman R. Composite international diagnostic interview. Copenhagen: WHO, 1982. 4. DSM III. Diagnostic and statistical manual of mental disorders, 3rd ed. Washington, DC American Psychiatric Association, 1980
IRRITABILITY
SIR,-Your Nov 30 editorial (p 1223) should perhaps have been entitled Irritability with Psychiatric Nosologists. We share some of your views, but your diatribe against names or categories given to disorders is not constructive. You offer no solution to the "utter confusion"; surely, terms such as paranoid schizophrenia are more helpful in communication than no system at all. You dismiss our paper,which is the first attempt to define irritability in a medical context. We did not offer a new category of "irritability neurosis". What we did was offer a definition of irritability and consider how this defined state differed from the concepts of hostility and aggression. We then drew attention to the many areas of medical and psychiatric practice in which irritability might be a prominent feature and in so doing we hoped that the concept might be studied scientifically. You conclude that "Psychiatric nosology remains utterly confused" but surely attempts to offer definitions should be
SIR,-Atrial natriuretic polypeptide(s) (ANP) isolated from atrial tissue has potent diuretic, natriuretic, and vasorelaxant activities in manl2 and is thought to be an endogenous antihypertensive agent. Using a radioimmunoassay for human a-ANP (a-hANp)3,4 we demonstrated large amounts of a-hANP-like immunoreactivity (a-hANP-LI) in the human atrium3 and found that a-hANP is released from the heart and circulates in the body as a hormone. We need to know if ANP secretion from the heart into the blood is decreased in essential hypertension because several lines of evidence 6 suggest a close link between sodium regulation and hypertension, and, besides being a circulating sodium transport inhibitor, ANP is implicated in the control of water and electrolyte balance and blood pressure. We have measured concentrations of a-hANP-LI in the plasma of ten patients with essential hypertension before treatment and in fourteen age-matched normotensive controls. The patients had stage I (five), stage II (three), and stage III (two) hypertension on the World Health Organisation classification.Blood was sampled and blood pressure measured at 0900 hours with the subject recumbent and after an overnight fast. Plasma a-hANP-LI in patients with essential hypertension (before treatment) was 77 - 8 (SEM 9 - 5) pg/ml; in the controls it was 37 - 8 (6 - 0) pg/ml (p<0 0 1) (see figure). Plasma levels ofa-hANP-LI in the five patients with WHO stage I hypertension (67-77 [ 10 0] pg/ml) was also significantly higher than that of the controls (p<0 . 05). Concentrations in patients with plasma renin activities
countered
by
calm debate about the failure of the definition and
guidance to a better one. HAD
Self-assessment
Climcal assessment
0-65 0-69
0-44 0.62
Anxiety Depression All r values
significant (p<0
00 1).
Department of Psychiatry, University of Leeds, St James’s University Hospital,
R. P. SNAITH C. M. TAYLOR
Leeds LS9 7TF
Thus the HAD scale correlates well with other self-assessment and clinical assessment scales, the clinical ones requiring a long interview with a highly trained person. Our interest in the epidemiology of anxiety and depression in medical populations prompted us to wonder if the use of this instrument could be extended from a symptomatic approach to a diagnostic one. We did a second study, this time in 133 patients admitted to the same hospital department.2 We compared HAD results with those of a structured questionnaire adapted from the composite international diagnostic interview.3 This interview4 permits the diagnosis of affective disorders according to DSM 111. The results, with a current major depressive episode as an external validation criterion, vary greatly according to the cut-off score of the HAD:
Taylor CM Irritability Definition, assessment and associated factors. Br J Psychiatry 1985, 147: 129-36
1. Snaith RP,
EFFECTS OF 1983 MENTAL HEALTH ACT
SIR,-In 19841 we reported a reduction in the use of emergency and 6 month orders for the first six months after the new mental health legislation came into force on Sept 30, 1983. This change has been maintained, as has the change to using the 28 day order in preference to the 6 month and emergency orders (table). IMPACT OF
1983 MENTAL
HEALTH LEGISLATION ON ADMISSIONS
UNDER SECTION
HAD
Cut-off Senmivlly (%) 8 9 10 11
77-7 72.2 69-4
SpecificllY (%) 80-4 83-5 87.6 90-7
PVP (%) 59-6 61-9 67-9 67-8
PVN (%)
52’8 PVP, PVN=predicuve values of positive, negative result.
90-7 89 88,5 83-8
Thus, as the cut-off increases, sensitivity is reduced while specificity improves. Since there is a high prevalence of anxious and depressive disorders in medical patients, a quick assessment scale to evaluate the degree of psychopathology is of interest. However, even though the HAD scale correlates with other quantitative psychopathological scales, one must be careful when using it for diagnostic purposes. Used to evaluate the prevalence of depression in medical settings (outpatient or inpatient), this assessment scale can only provide an estimate of depressive symptoms; it cannot be used to study depressive disease.
*Sections of 1959 Mental Health Act
m
parentheses Years in this table run Oct 1 to Sept 30.
These findings suggest that, for Southampfon, the changes noted for the first six months were not the transitory result of the novelty of a new procedure, but a permanent change in medical and social work practice before people are, in their own interests, deprived of
liberty. Department of Psychiatry, Royal South Hants Hospital, Southampton SO9 4PE
M. J. WINTERSON B. M. BARRACLOUGH
MJ, Barraclough BM. Effects of 1983 Mental Health Legislation compulsory admissions to a District General Hospital Lancet 1984, ii. 44
1 Winterson
Psychiatric and Internal Medicine Services, Hôpital Bichat,
J. P. LEPINE M. GODCHAU P. BRUN
75018 Paris, France
on
PLASMA CONCENTRATION OF ATRIAL NATRIURETIC POLYPEPTIDE IN ESSENTIAL
HYPERTENSION 1.
2.
Lepine JP, Godchau M, Brun P, Lemperière Th. Evaluation de l’anxiété et de la dépression chez des patients hospitalisés dans un service de médecine interne. Ann Médico-Psychol 1985; 2: 175-89. Lepine JP, Godchau M, Brun P. Utilité des échelles d’auto-évaluation de l’anxiété et de la dépression en médecine interne. Presented at 3rd International Congress of the International Federation of Psychiatric Epidemiology (Brussels, Sept 9-11, 1985) Abst 119.
3. Wing J, Robins L, Helzer J, Stoltzman R. Composite international diagnostic interview. Copenhagen: WHO, 1982. 4. DSM III. Diagnostic and statistical manual of mental disorders, 3rd ed. Washington, DC American Psychiatric Association, 1980
IRRITABILITY
SIR,-Your Nov 30 editorial (p 1223) should perhaps have been entitled Irritability with Psychiatric Nosologists. We share some of your views, but your diatribe against names or categories given to disorders is not constructive. You offer no solution to the "utter confusion"; surely, terms such as paranoid schizophrenia are more helpful in communication than no system at all. You dismiss our paper,which is the first attempt to define irritability in a medical context. We did not offer a new category of "irritability neurosis". What we did was offer a definition of irritability and consider how this defined state differed from the concepts of hostility and aggression. We then drew attention to the many areas of medical and psychiatric practice in which irritability might be a prominent feature and in so doing we hoped that the concept might be studied scientifically. You conclude that "Psychiatric nosology remains utterly confused" but surely attempts to offer definitions should be
SIR,-Atrial natriuretic polypeptide(s) (ANP) isolated from atrial tissue has potent diuretic, natriuretic, and vasorelaxant activities in manl2 and is thought to be an endogenous antihypertensive agent. Using a radioimmunoassay for human a-ANP (a-hANp)3,4 we demonstrated large amounts of a-hANP-like immunoreactivity (a-hANP-LI) in the human atrium3 and found that a-hANP is released from the heart and circulates in the body as a hormone. We need to know if ANP secretion from the heart into the blood is decreased in essential hypertension because several lines of evidence 6 suggest a close link between sodium regulation and hypertension, and, besides being a circulating sodium transport inhibitor, ANP is implicated in the control of water and electrolyte balance and blood pressure. We have measured concentrations of a-hANP-LI in the plasma of ten patients with essential hypertension before treatment and in fourteen age-matched normotensive controls. The patients had stage I (five), stage II (three), and stage III (two) hypertension on the World Health Organisation classification.Blood was sampled and blood pressure measured at 0900 hours with the subject recumbent and after an overnight fast. Plasma a-hANP-LI in patients with essential hypertension (before treatment) was 77 - 8 (SEM 9 - 5) pg/ml; in the controls it was 37 - 8 (6 - 0) pg/ml (p<0 0 1) (see figure). Plasma levels ofa-hANP-LI in the five patients with WHO stage I hypertension (67-77 [ 10 0] pg/ml) was also significantly higher than that of the controls (p<0 . 05). Concentrations in patients with plasma renin activities